tbuckley/cabot-search huggingface dataset:
Abstract 15639: Infected Thrombus - An Unusual Etiology of Acute Coronary Syndrome in a Patient With New Onset Atrial Fibrillation
Authors: Adeniyi Okunade, Olubadewa Fatunde, maxwell L smith, Tasneem Z Naqvi
Journal: Circulation (2022)

Background: Coronary embolism (CE) is an uncommon (3%) cause of acute coronary syndromes (ACS) and is often missed. Case Presentation: A 68-year-old woman with a h/o hypertension &amp; breast cancer post lumpectomy 10 yrs ago, presented with generalized weakness, fever (101F), &amp; vomiting without chest pain, dyspnea, or palpitations. She was afebrile, tachycardic (158 beats/min), tachypneic (26 breaths/min) with BP of 98/64 mmHg. Cardiac exam revealed irregularly irregular rhythm, 5 cm jugular venous distension &amp; 3+ bilateral pretibial edema. Labs revealed thrombocytopenia, lactic acidosis, &amp; hyponatremia. High sensitivity-Troponin was 1023 &amp; NT-pro-BNP 19854. EKG showed atrial fibrillation (AF), diffuse ST elevations in the precordial leads &amp; aVR, poor R wave progression &amp; inferior Q waves. Her cardiac cath revealed a large thrombus from mid-left main extending into the LAD with minimal atherosclerotic burden. Intraoperative transesophageal echocardiogram for emergent surgical resection of the thrombus revealed a highly mobile thrombus 2.32x0.6 cm on the aortic aspect originating between L and R coronary cusps and a left atrial appendage thrombus (1.1 cm) with marked spontaneous contrast in LA appendage &amp; LA which was surgically resected. Blood cultures &amp; of coronary thrombus grew Methicillin sensitive Staphylococcus Aureus (MSSA) . Anticoagulation &amp; appropriate antibiotics were initiated. but after a protracted, complicated ICU stay, patient was made comfort care. Discussion/Conclusion: CE should be considered in cases of recurrent coronary thrombus or in the setting of heavy thrombus burden despite a relatively normal coronary vessel. AF is the most common underlying cause of CE causing ACS. Aspiration or surgical thrombectomy should be performed with a high thrombus burden. Thrombus should be sent for pathology to further delineate the source of thrombus.
Abstract 14713: Long-Term Clinical Outcomes in Patients With Chronic Total Occlusion of Single Coronary Artery Treated With Percutaneous Coronary Intervention versus Optimal Medical Therapy: A Ten-Year Follow Up Study
Authors: Sungeun Kim, Taek Kyu Park, Seung-Hyuk Choi
Journal: Circulation (2022)

INTRODUCTION : Only limited data are available and long term follow up studies are insufficient about optimal treatment in patients with chronic total occlusion of a single coronary artery.METHODS : A total of 2,024 patients with CTO were retrospectively enrolled in Samsung Medical Center CTO registry between March 2003 and February 2012 and followed-up for 10 years. Patients underwent coronary artery bypass graft (n = 477) and Patients with multi-vessel CTO (n = 1,112) were excluded. Finally patients with chronic total occlusion of a single coronary artery (n = 435) were analyzed. Divided into two groups, optimal medical group (OMT, n = 147) and percutaneous coronary intervention group (PCI, n = 288) in accordance with initial treatment strategy. Cox regression analysis and propensity score matching was performed to adjust for confounding factors. Primary outcome was cardiac death.RESULT : During the follow up 10 years, we identified that there were no significant differences between OMT group and PCI group in rate of cardiac death (adjusted HR, 0.57 [95% CI, 0.26-1.24]; P=0.16) as well as rate of major adverse cardiac event (adjusted HR, 0.79 [95% CI, 0.52-1.19]; P=0.26) . After propensity score matching analyses, OMT group and PCI group still have no significant differences in rate of cardiac death (adjusted HR, 0.54 [95% CI, 0.24-1.19]; P=0.13) and rate of MACE (adjusted HR, 0.97 [95% CI, 0.62-1.52]; P=0.89).CONCLUSION : This retrospective observational study supported that as an initial treatment strategy in patients of single vessel CTO, PCI did not decrease the rate of cardiac death or MACE. KEYWORD : Chronic total occlusion, Optimal medical treatment, Percutaneous coronary intervention
Abstract 15681: Impact of Dietary Sodium Restriction on Heart Failure Outcomes: A Systematic Review and Meta-Analysis
Authors: Tariq J Siddiqi, Muhammad Shariq S Usman, Ahmed K Siddiqi, Ahmed Mustafa Rashid, Daisuke Kamimura, Tariq Shafi, Jeffrey M Testani, Ambarish Pandey, Robert J Mentz, Javed Butler, Michael E Hall
Journal: Circulation (2022)

Introduction: Although heart failure (HF) guidelines emphasized dietary sodium restriction, the recommendation was based on limited evidence. We analyzed the impact of dietary sodium restriction on HF outcomes and quality of life (QoL) by systematically reviewing the available literature to-date. Methods: MEDLINE and SCOPUS were queried from inception till April 2022 for randomized controlled trials (RCTs) and observational studies with sodium restriction (≤1500-3000mg) as an intervention/comparator and assessing its impact (or association) on HF outcomes. Data about HF-related hospitalizations, all-cause mortality and QoL (via the Kansas City Cardiomyopathy Questionnaire) was extracted, pooled and analyzed. Forest plots were created based on random effects model. Results: Twelve studies (n= 4637 patients) were included in our analysis with a median follow-up time of 6 months. The pooled analysis demonstrated no difference in HF hospitalizations between the sodium-restricted and unrestricted groups (OR = 1.30 [0.81-2.10] P&lt;0.28) (Figure 1a). However, a significantly higher risk of all-cause mortality was observed associated with sodium-restriction (OR = 1.68, 95% CI: 1.26-2.24, P&lt; 0.0004) (Figure 1b). Dietary sodium restriction was not associated with QoL (mean difference = 0.14, 95% CI: -0.07-0.35, P&lt; 0.18). (Figure 1c). Conclusions: Our observations suggest that sodium restriction in patients with HF may not improve QoL or reduce hospitalizations, but is associated with increased risk of mortality.
Abstract 15703: Outcomes of Non-ST Segment Myocardial Infarction in Patients With Heart Failure and End Stage Renal Disease
Authors: Majd Al Deen Alhuarrat, Dimitrios Varrias, Snehal R Patel, Daniel B Sims, Azeem Latib, Ulrich P Jorde, Omar Saeed
Journal: Circulation (2022)

Introduction: Non-ST Segment Myocardial Infarction (NSTEMI) occurs frequently in patients with pre-existing Heart Failure (HF) and End Stage Renal Disease (ESRD). However, outcomes with invasive approaches such as percutaneous coronary intervention (PCI) or medical management remain uncertain. Hypothesis: Given severe comorbidity burden, patients with HF and ESRD admitted for NSTEMI may experience higher in-hospital mortality with an invasive strategy of PCI. Methods: We utilized the National Inpatient Sample to capture hospitalizations in the United States from 2006-2014. Admissions for NSTEMI were identified by the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) code 401.7x. The sample was further narrowed by coexisting diagnoses of HF (ICD-9-CM: 428.xx) and ESRD (ICD-9-CM 585.6). The cohort was divided into those that received PCI or medical management only. Multivariable logistic regression was used to compare the primary outcome of in-hospital mortality between invasive and medical management only groups. Results: During the study period, 14,333 hospitalizations were identified for NSTEMI in patients with coexisting HF and ESRD. Within this cohort, 3,549 (25%) underwent PCI (age: 66±11 years,42% female) and 10,784 (75%) were managed with medications (age: 69±12 years, 45% female) only. In-hospital mortality was 5% in the PCI group in comparison to 10% in those managed with medications only (p&lt;0.01). After adjustment for clinical covariates including age, sex and diabetes mellitus, PCI was associated with lower odds of death during hospitalization (aOR: 0.52, 95% CI: 0.44-0.61, p&lt;0.01). Conclusions: Patients with HF and ESRD admitted for NSTEMI do not incur greater in-hospital mortality with PCI, despite a high burden of comorbidities. Invasive percutaneous revascularization may be reasonable for appropriately selected patients with HF and ESRD.
Abstract 201: Resuscitation And Hemodynamic Impact Of Aortic Balloon Occlusion And Percutaneous Left Ventricular Assist Device In A Swine Model Of Cardiac Arrest
Authors: Mohamad H Tiba, Takahiro Nakashima, Brendan McCracken, Cindy H Hsu, Adam Gottula, Nicholas Greer, Traci Cramer, Nadia R Sutton, Kevin R Ward, Robert W Neumar
Journal: Circulation (2022)

Introduction: Invasive mechanical support by percutaneous left ventricular assist device (pL-VAD) and percutaneous balloon occlusion of the aorta (pAO) during CPR have recently emerged as feasible resuscitation strategies for refractory cardiac arrest. It is unknown if combining pL-VAD and pAO has additive or synergist benefits during CPR. Hypothesis: Combined pAO and pL-VAD during CPR will significantly enhance coronary and cerebral perfusion pressure (CoPP, CePP), return of spontaneous heartbeat (ROSHB) rate, and post-ROSHB cardiac function compared to either therapy alone after prolonged cardiac arrest in a swine model. Methods: Nineteen swine 52 (3.9) kg; (9 male) were utilized. A pL-VAD (Impella CP®) and a balloon catheter were inserted through the femoral arteries under general anesthesia. Ventricular fibrillation was induced and left untreated for 8 minutes followed by 16 minutes of mechanical CPR (mCPR). Animals were randomized to 3 treatment groups A) pL-VAD (n=6), B) pL-VAD+pAO (n=6), and C) pAO (n=7). Treatment was initiated 24 minutes after arrest. mCPR was continued during treatment. Defibrillation was attempted 3 times starting at minute 28 and then every 4 minutes. Hemodynamics, cardiac function, and blood gases were monitored for 4 hours after ROSHB. Results: Following the intervention, CoPP for Group B increased by a mean (SD) of 26 (15) mmHg which is significantly different from both groups A and C, 3.6 (12) and 7.5 (6.3) mmHg ( p =0.007). CePP increased by 2 (11.5), 18.5 (18.6), and 8.3 (6.8) mmHg for groups A, B, and C with no significant differences ( p =0.06). The rate of ROSHB was 67% (4 of 6), 83% (5 of 6), and 100% (7 of 7) for groups A, B, and C ( p &gt;0.05). All groups exhibited similar levels of post-ROSHB recovery including blood pressure, venous oxygen saturation, cardiac output, ejection fraction, and lactate clearance. Total ionotropic and vasopressor support (epinephrine and norepinephrine) was 56 (25), 50 (5), and 81 (90) mcg/Kg in groups A, B, and C ( p =0.66). Conclusion: Combined pAO and pL-VAD resulted in greater improvement of CPR hemodynamics compared to either intervention alone in this model of prolonged cardiac arrest. However, it remains unclear if this translates into better recovery of cardiovascular and neurological function.
Abstract 14697: Chronic Medication Burden for Patients After Congenital Heart Surgery: A 14-Year Statewide Analysis of Publicly Insured Patients
Authors: Joyce L Woo, Katherine A Nash, Kacie Dragan, Sarah Crook, Matthew Neidell, Stephen Cook, Edward L Hannan, Jane W Newburger, Marshall L Jacobs, Emile A Bacha, Robert Vincent, Kathleen Walsh-Spoonhower, Ralph S Mosca, TK Kumar, Neil Devejian, Steven A Kamenir, George M Alfieris, Michael F Swartz, David Meyer, Erin A Paul, John Billings, Brett R Anderson
Journal: Circulation (2022)

Introduction: Data on the longitudinal health experience after pediatric cardiac surgery are limited. We examined chronic medication use by cardiac disease severity amongst publicly insured children in New York State over the course of childhood. Methods: We identified Medicaid-enrolled youth &lt;18 years with a history of cardiac surgery in the NYS CHS-COLOUR database, which links clinical registry data to 14 years of New York State Medicaid data (2006-2019). We report total expenditures and prevalence of outpatient chronic medication use, defined as &gt; 90 days of a filled prescription. Results: Of 4.5 million children enrolled in Medicaid, 5,459 underwent cardiac surgery. Chronic medication expenditures were $4.1K/person-year for those with critical single ventricle disease (SV), $2.4K/person-year for critical biventricular disease (BV), $2.4K/person-year for non-critical cardiac disease (non-critical), and $0.3K/person-year for enrollees without a history of cardiac surgery (non-cardiac). Prevalence of chronic medication use was 0.65 (SV), 0.38 (BV), 0.37 (non-critical), and 0.15 (non-cardiac) enrollees/person-year. Prevalence of chronic medication use was higher for enrollees with cardiac surgery compared to non-cardiac enrollees: 16 times higher for cardiac/renal medications, 1.9 times higher for respiratory/allergy, 7.4 times higher for gastrointestinal, and 0.8 times higher for central nervous system medications (primarily driven by antiepileptics in enrollees &lt;1 year and by psychotropics in adolescents). For enrollees with a history of cardiac surgery, patterns of medication use differed by age, medication type and disease severity (higher for SV compared to similar patterns of use for BV and non-critical, Figure ). Conclusion: Chronic medication use is common and costly even years after pediatric cardiac surgery. Understanding longitudinal medication burden helps clinicians and families plan for future healthcare needs.
Abstract 15718: Higher In-Hospital Mortality Among Cardiogenic Shock Patients With <i>De Novo</i> versus Acute on Chronic Heart Failure
Authors: Vanessa Blumer, Jaime Hernandez-Montfort, Shashank S Sinha, Manreet Kanwar, Arthur Reshad Garan, Yijing Zhang, BORUI LI, Paulina Baca, Fatou Dieng, Neil Harwani, Daniel Burkhoff, Navin K Kapur
Journal: Circulation (2022)

Introduction: Heart failure cardiogenic shock (HF-CS) constitutes a heterogenous population and has been identified as the leading type of shock among contemporary intensive care units. The in-hospital trajectory of shock severity and its association with mortality and transition to heart replacement therapy (HRT) or native heart survival (NHS) based on HF-CS phenotype has not been well described. Methods: The Cardiogenic Shock Working Group (CSWG) registry includes patients from 17 hospitals between 2016 and 2021. For this analysis, HF-CS patients were sub-classified as having de novo HF-CS or acute-on-chronic (ACHF) CS. In-hospital trajectories were assessed using baseline and maximum Society for Cardiovascular Angiography and Interventions (SCAI) stages and clinical outcomes were analyzed. Results: A total of 1,767 patients with HF-CS were included. Of these, 349 had de novo HF-CS (19.8%) and 1,371 (77.6%) had ACHF-CS. Overall, patients with de novo HF-CS had greater in-hospital death (32% vs 22%), NHS (58% vs 45%) and less HRT (33% vs 10%) when compared to ACHF-CS (all p&lt;0.001). These variances in clinical outcomes differ when analyzed according to SCAI stages, with more significant differences between de novo HF-CS vs. ACHF-CS across baseline and maximum SCAI Stages C-D (Figure). Conclusions: Using a large contemporary real-world dataset of HF-CS, we identified that de novo HF-CS is associated with higher in-hospital mortality and NHS and lower HRT compared to ACHF-CS. These differences vary depending to SCAI Stage and are more pronounced in SCAI Stages C and D. Further efforts to define shock trajectories and to tailor therapeutics in HF-CS patients are urgently needed.
Abstract 15588: Effect of Covid-19 on the Mortality of Patients With Congenital Heart Disease
Authors: Yanxu Yang, Eugene Huang, J'Neka Claxton, Kristina W Kuo, Matthew Oster, Lazaros Kochilas
Journal: Circulation (2022)

Introduction: Cardiovascular conditions have been recognized as risk factors for poor outcomes in association with COVID-19. However, the effect of the COVID-19 pandemic on different severity types of congenital heart disease (CHD) patients remains unknown. This study aims to examine whether patients with history of interventions for CHD experienced a higher mortality risk during the COVID-19 pandemic. Methods: This is a retrospective cohort study using data from the Pediatric Cardiac Care Consortium (PCCC). We included patients having US residence and direct identifiers, who were enrolled between 1982 and 2003 after undergoing transcatheter or surgical interventions for CHD. The observation window (2017-2020) was divided to a pre-SARSV2 and SARSV2 exposure period defined around the state specific onset of COVID-19 disease in 2020. Patients were categorized as having mild, moderate, severe-2 ventricle (2V) or single ventricle (SV) CHD. Standardized mortality ratios (SMRs) were used to describe the observed risk of mortality in CHD patients compared to the age- and sex-adjusted rates from the general U.S. population. Multivariable analysis was conducted using time-varying covariate Cox proportional hazards model with adjustment for age, sex and severity of CHD. Results: A total of 50,138 patients with history of interventions for CHD were included. Pooled pre-SARSV2 SMR was 2.38 [95% CI: 2.06, 2.75], while the SARSV2-exposure SMR was 2.07 [95% CI: 1.78, 2.35] (not significantly different). No significant differences in pooled SMRs were found by severity of CHD. The adjusted hazard risk for all-cause mortality in the SARSV2-exposure vs pre-SARSV2 period did not increase for patients with CHD (aHR: 0.59, 95%CI:0.19 - 1.84), and we did not find any differences in risk by severity subgroups or sex of patients. Conclusion: In this large cohort study monitoring long term outcomes after interventions for CHD, we could not detect any evidence of increased risk for all-cause mortality among this population during the early part of the COVID-19 pandemic. Additional data will be required over longer period to fully understand the impact of COVID-19 on adults with repaired CHD.
Abstract 15690: Bioactive Fumarate Improves Cardiac Function and Expands Lifespan in Friedreich's Ataxia
Authors: Lili Salinas, Francisco Figueroa, Claire Montgomery, Phung Thai, Nipavan Chiamvimonvat, Sundeep Dugar, Somdutta Sen, Gino Cortopassi, Elena N Dedkova
Journal: Circulation (2022)

Introduction: Friedreich ataxia (FA) is a monogenic recessive ataxia caused by reduction of a single mitochondrial protein, frataxin (FXN). Although the name of FA refers to the neurodegenerative ataxia, the lethal event is cardiomyopathy, caused by deficient FXN expression in the heart. Previously, we identified that bioactive fumarates are protective in FA cell models. We have developed a novel monomethyl fumarate prodrug, IMF, which has much improved pharmacokinetic profile and compared its effect to the known fumarate prodrug dimethyl fumarate (DMF, Tecfidera). Aim: To test the hypothesis that novel bioactive fumarate improves cardiac function and survival via Nrf2 and HCA 2 signaling pathways activation. Methods and Results: Cardiospecific FXN knockout (FXN Mck-Cre KO) mice were used as a model of severe cardiomyopathy which is characteristic for the late stage of FA. Animals of either sex were randomly split in vehicle and fumarate-treated groups. Animals were treated by IMF or DMF at concentrations which release equimolar amount of monomethyl fumarate. Treatment started at 3 weeks of age and continued for 5 weeks in the cross-sectional study or until animal death in the survival study. Cardiac function was examined in-vivo by echocardiography. We found that FXN Mck-Cre KO mice developed severe heart failure with 45% reduction in ejection fraction, increased left ventricular (LV) mass (+80%) and diameter (+308%), decreased stroke volume (-26%) and cardiac output (-38%, n=10) as compared to WT mice (n=12). Cardiac deficits were more pronounced in FA males compared to females. Both DMF and IMF partially recovered cardiac deficits in FXN Mck-Cre KO mice but only IMF extended the lifespan in these mice by 13%. Expression of genes in Nrf2 (NQO1, SOD2, glutathione S-transferase) and HCA 2 (HCA 2 and Sirt1) signaling pathways were decreased in FXN Mck-Cre KO and restored to a different degree by DMF and IMF. Aconitase activity, used as a surrogate measure of frataxin's iron-sulfur biogenesis function, was decreased in FA by 49% and recovered 18% by IMF only. Conclusions: Novel fumarate prodrug IMF improved cardiac function and expanded the lifespan in FXN Mck-Cre KO mouse model of FA more effectively than DMF.
Abstract 15541: Potentially Adaptive Mt-trna Expression Regulation in Severe Metabolic Dysfunction
Authors: Ashley Francois, Matthew Gorr, Erin MCGRAIL, Matthew Stratton
Journal: Circulation (2022)

Metabolic dysfunction is increasingly appreciated as characteristic of heart failure, particularly heart failure associated with advanced age. Mice harboring a mutant form of Polymerase Gamma (D257A, POLG), the mitochondrial DNA polymerase, display severe metabolic dysfunction, accelerated aging, and cardiac dysfunction. We recently reported sex specific aspects of cardiac remodeling in this model. We also proposed posttranscriptional/non-canonical activation of the mitochondrial unfolded protein response (mtUPR) in the POLG mutant based on analysis of nuclear encoded gene expression and available mass spectrometry data. Subsequent analysis of mitochondria encoded gene expression in the POLG mutant provides further support for the notion of alternate activation of the mtUPR in the POLG mutant heart. Specifically, we identify a pattern of differential mitochondrial tRNA (mt-tRNA) expression that shows surprising dependence on mt-tRNA chromosomal location as clusters of mt-tRNAs throughout the mitochondrial chromosome show similar expression change. Importantly, specific mt-tRNA expression changes negatively correlate (p=0.0017) with the propensity of the charged amino acid to be found in an amyloid fold. Thus, in addition to the mt-UPR impacting nuclear encoded gene expression, a yet unidentified mechanism exists to minimize protein missfolding in the mitochondria via regulation of mitochondrial tRNA expression.